16 June 2003

African sexual health programmes "misguided"

Since the beginning of the AIDS epidemic, experts have assumed that anal sex was virtually non-existent in Sub-Saharan Africa. In the July International Journal of STD and AIDS, medical psychologist Dr Stuart Brody and epidemiologist Mr John Potterat describe "compelling evidence" to challenge this view. Their study, which is based on a cross-disciplinary review of decades of research across Africa, has important implications for HIV prevention programmes.

Public health warnings
Currently, anti-AIDS education in Africa focuses on 'heterosexual transmission', usually taken to mean vaginal sex. According to Brody and Potterat, the fact that health warnings have avoided mentioning anal sex - despite its "substantially greater" risk of HIV transmission - may have contributed to the AIDS epidemic. Their research suggests that both men and women in Africa have receptive anal intercourse, often believing it to be 'safe' since it is not featured in public health education programmes.

Some facts from the study:

• Anthropological reports of African male homosexuality date back to the early 17th century. Referring to male homosexual behaviour in Angola, Falk observed in 1923: "...while the act is permitted, speaking about it is considered disgusting"
  
• In sample studies, 42% of South African truck drivers, 35% of young Zimbabweans, and 41-75% of South African prostitutes reported engaging in heterosexual anal intercourse
  
• Rectal diseases similar to those found in American homosexual men have been reported in some studies of African men
  
• Receptive anal intercourse was reported by 98.7% of street boys in Tanzania, who said they weren't at risk from AIDS, because they thought you could only get it if you had sex with a woman

Conclusions:
The authors conclude that although unsafe medical practices probably caused most of the spread of HIV in Africa, anal intercourse accounts for perhaps the majority of the remainder. Brody warns: "No one is warned about the dangers of anal intercourse, and people are dying as a result."

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